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What is an exercise physiologist?

What is an exercise physiologist?

An Accredited Exercise Physiologist (AEP) is a university qualified allied health professional who specialises in the delivery of exercise and lifestyle programs for healthy individuals and those with chronic medical conditions, injuries or disabilities.   AEPs possess extensive knowledge, skills and experience in clinical exercise delivery. They provide health modification counselling for people with chronic disease and injury with a strong focus on behavioural change.   Working across a variety of areas in health, exercise and sport, services delivered by an AEP are also claimable under compensable schemes such as Medicare and covered by most private health insurers. When it comes to the prescription of exercise, they are the most qualified professionals in Australia.   What makes AEPs different to other exercise professionals?
  • They are university qualified
  • They undertake strict accreditation requirements with Exercise and Sports Science Australia (ESSA)
  • They are eligible to register with Medicare Australia, the Department of Veteran’s Affairs and WorkCover, and are recognised by most private health insurers
  • They can treat and work with all people. From those who want to improve their health and well-being, to those with, or at risk of developing a chronic illness
Why should you see an AEP? AEPs are the experts in prescribing the right exercise to help you prevent/manage your chronic disease, help you recover faster from surgery or an injury, or help you to maintain a healthy lifestyle.   AEPs can help treat and/or manage:
  • Diabetes and pre-diabetes
  • Cardiovascular disease
  • Arthritis and osteoporosis
  • Chronic respiratory disease and asthma
  • Depression and mental health conditions
  • Different forms of cancer
  • Musculoskeletal injuries
  • Neuromuscular disease
  • Obesity
  • And much more!
    What makes AEPs even more special is they know how to set goals and maintain motivation, these are two aspects that will most commonly see people fail at exercise. What to expect when seeing an AEP?   During an initial consultation with your AEP, you will undertake a comprehensive assessment in order to develop an exercise plan based on your unique requirements. This session will likely be a fair few questions about your health and history. A lot of people are concerned about what to wear to this appointment. We always say wear comfortable clothing as you may be asked to do a range of movements and bring some comfortable walking shoes as you may need to complete an aerobic assessment. After this session, you will be provided with a plan of action. Working with an AEP can be a truly rewarding process and they can make a hugely positive impact to your life. Our AEP, Sammy, has special interests in the areas of Cancer and Exercise, Osteoporosis and Clinical Pilates. To make a booking with Sammy our AEP  please call 6676 4000 or 6676 4577.  

Cancer and Exercise

      The potential benefits of exercise during and after treatment are significant and research has proved its effectiveness. Exercise during chemotherapy can help ease side effects, such as fatigue and nausea, and can help to boost the immune system of those undergoing cancer treatments. Chemotherapy side effects can sometimes make exercising tough, but it’s recommended to try to be as active as possible during treatment. Benefits of an appropriately prescribed exercise program in this population include improved:

  • Muscle mass, strength, power
  • Cardiorespiratory fitness
  • Physical function
  • Physical activity levels
  • Range of motion
  • Immune function
  • Chemotherapy completion rates
  • Reduced anxiety and depression

Balance – Are you Losing your Balance?

Losing some of our balance is part of the ageing process.

This can become a problem for older adults, making them more susceptible to falls and injury.

The good news?

Exercise and balance training can help to prevent falls.

Frequent falls can not only lead to injuries, but can also hinder one’s ability to live independently. Although losing our balance appears to be the number one cause of falls in older adults, we can start to have falls for a number of reasons. Some of these include:
  • Loss of lower limb strength/sensation
  • Cognitive impairments/slowed reaction times
  • Multiple medications
  • Poor eye sight
  • Poor grip strength
   Although exercise may not be able to improve things like eyesight, it can significantly improve your strength, body awareness and help improve your cognitive ability! Exercise alone has been shown to effectively prevent falls when delivered to people within the community. The amount of risk reduction and rate of falls reduction has been shown to be anywhere between 20% – 35% with the introduction of a balance and strength program. It is recommended to complete at least 2 hours of structured exercise per week for the prevention of falls. This exercise should not only include balance exercises, but also some strength training! This also doesn’t mean that 2 hours has to be done in a single session. Do what works best for you. It may be 20 minutes of training everyday of the week, 30 minutes every second day, or an hour of exercise completed twice a week. Balance training should be of a difficulty that poses a challenge and may cause one to lose their balance, but does not place them at risk of having a fall. Some balance exercises may include:
  • Standing on unstable surfaces
  • Adapting and holding difficult postures
  • Functional exercises like step taps
  A decrease in lower limb (and even upper limb) strength has been identified as a risk factor for falls. It’s therefore important to train for strength too. It’s never too late to start lifting weights! Strength training may include using your own bodyweight, bands, weights and cable machines to provide resistance. Interestingly, those people who are susceptible to falls and already have frequent falls aren’t recommended to walk as a form of exercise. Walking increases the exposure and chance that we may catch our foot on one of those sneaky cracks in the pavement and fall. Research suggests it’s best to get balanced and strong again before heading out for a stroll.

Although exercise is a fantastic way to decrease your falls risk, there are more benefits! You can improve flexibility, manage weight, and reduce your risk of developing chronic conditions like cardiovascular disease, diabetes and osteoporosis. Regular physical activity can also improve your mental health.


What is Osteoporosis?

What is Osteoporosis?

Osteoporosis is a condition in which the bones lose calcium, become fragile and tend to fracture readily. It is most common in women over 40 years of age. Your doctor may organize a bone density scan to see if you have, or are at risk of developing osteoporosis.

What causes Osteoporosis?

  Throughout life bone tissue is very active and is constantly being ‘remodelled’. Microscopic amounts of bone are continually being removed and reformed. The bone continues to thicken until your early 20’s, this is your peak bone mass. After about 40 or 50 years more bone is removed then laid down, and gradually the density decreases. During menopause the decline in oestrogen levels results in an accelerated bone loss.  

Who is at risk?

  • Over 40 years old
  • Family history
  • Caucasian
  • Women after menopause
  • Smokers
  • High intake of alcohol, salt, caffeine
  • Sedentary lifestyle
  • If you have dieted during your life and limited intake of calcium rich foods.

Exercise and Osteoporosis

  Research shows that regular lifelong weight bearing exercise and light weight training has a positive effect on bone density. Swimming and cycling although good for your fitness are not as beneficial as walking, dancing, tennis or gentle weight bearing circuit classes. Bone is a living tissue and responds to the stress of weight bearing exercise by becoming stronger. You need to aim for at least three sessions per week. IT IS NEVER TOO LATE TO START, even if you are past your peak bone mass, exercise will reduce bone loss and help delay the progress of Osteoporosis. Pottsville Physiotherapy Fit for Life circuit classes incorporate weight bearing exercise, light resistance training and balance / coordination training to help maintain your bone density, improve your posture and balance and help prevent falls. Exercise to avoid: If you have been diagnosed with osteoporosis you will need to avoid excessive twisting, bending, heavy lifting, jolting, dynamic sit ups, and high impact activities such as running and jumping.

Exercise Tips

  • Warm up first
  • Slow and controlled movement
  • Don’t hold your breath
  • Do not push into pain

Other Treatments

  • Your doctor may prescribe medications i.e.- hormone replacement therapy
  • Diet and or supplements to ensure adequate calcium intake (your doctor or a dietician can advise you on this)
  • Lifestyle factors—quit smoking, decrease salt, alcohol and caffeine intake (these all limit calcium absorption)

How much calcium do I need?

  Young adults - 800-1200mg per day Menstruating women800-1000mg per day  Men800  Pregnant/lactating women  - 1200mg per day Post menopausal women(no oestrogen) - 1500mg per day Post menopausal women(oestrogen) - 1000 - 1200mg  per day Adults over 65 years -  1500mg per day     Food                                                       Amount                                              Calcium (mg)   Low fat milk                                         1 glass (250ml)                                                 405 Soya beverage                                   1 glass                                                                  365 Yoghurt                                                200g                                                                      330 Whole milk                                         1 glass                                                                  300 Hard cheese                                       1 slice (30g)                                                        285 Canned sardines inc bones           (50g)                                                                     275 Processed cheese                            30g                                                                        190 Oysters                                                10                                                                          190 Tofu                                                       100g                                                                     130 Almonds                                              50g                                                                        125 Baked beans                                       1 cup (240g)                                                       108 Canned salmon, inc bones            100g                                                                      90 Cottage cheese                                 100g                                                                      60mg Broccoli                                                60g                                                                        15mg   Pottsville and Cabarita Physiotherapy 6676 4000 visit www.osteoporosis.org.au

Have you been diagnosed with Parkinson’s disease and worried about what the future holds? 

Have you been diagnosed with Parkinson’s disease and worried about what the future holds? 

Do you want to optimise your quality of life now and in the future? Parkinson’s disease is a debilitating disorder, where nerve cells in a part of the brain that produce dopamine are affected. The nerve damage affects the brain’s control of the muscles, which causes shaking (tremor), increased muscle stiffness, slowed movements and balance problems. Parkinson’s disease also affects your thinking abilities, especially the ability to control and regulate behaviour, and may cause anxiety and depression. Drugs can control the symptoms in most patients, but unfortunately only for a limited time.

How can exercise help?

Exercise benefits the health and wellbeing of people with Parkinson’s disease in many ways. By increasing fitness, exercise protects against many complications of the disease. For example, better mobility may improve quality of life and prolong independent living. Exercise may also have positive effects on mood and improve brain function and make drug therapy more effective. It also provides a means by which individuals can actively participate in the management of their disease. Walking speed in people with Parkinson’s disease is related to muscle strength in the legs, so exercise programs focuses on  increasing leg strength are beneficial. Programs using resistance training like Clinical Pilates, increase muscle mass and strength, and also improve step length, walking speed and walking distance. Rhythmic stimulation of the brain via the eyes or ears while walking can help, and balance training combined with resistance training (like Clinical Pilates) can improve balance and stability. ‘Cueing exercises’ involve walking while listening or seeing cues that mimic the rhythm of walking. These exercises can help improve your walking movements and overcome difficulty with gait initiation and freezing. ‘Dance’ provides exercise to music that can facilitate functional and expressive movement. It also provides important social interaction and can lead to improvements in perceived quality of life. ‘Dual tasking’ exercises, where a secondary task (like counting backwards) while walking can help. These exercises usually try to improve one aspect of walking at a time.

The Parkinson’s Program we run at Pottsville and Cabarita Physio caters for individual abilities and incorporate all the above factors.

Novel ways you can boost your immune system this winter

Smile: you are less likely to catch a cold if you are happy and relaxedLet it go: anger creates a stress response that affects your hormones, neurotransmitters and gut flora (where 80% of your immune cells live)

Walk in the park, bush or beach: spending time in a green space boosts immunity by switching on the para sympathetic nervous system (rest and repair state)


Yoga or Pilates: bending and twisting is a natural immunity booster


Bounce: get on the trampoline or rebounded to flush the lymphatic system

Massage: even a self massage 5 minutes per day prior

Breathe: slowly and gently. Your breathing should be silent and invisible.

Spend some time in the sunshine

Move: don’t sit for more than 1-2 hours at a time

Overactive Bladder Syndrome (Urge Incontinence)

What is the Pelvic Floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. The pelvic floor has three openings that run through it, the urethra, the vagina, and the rectum.

The functions of the pelvic floor include:

  • To support the pelvic organs, specifically the uterus, the bladder, and the rectum
  • To help provide sphincter control for the bladder and bowel
  • To withstand increases in pressure that occur in the abdomen such as coughing, sneezing, laughing, straining, and lifting
  • To enhance the sexual response

What is Urge Urinary Incontinence?

Urge urinary incontinence is the involuntary release of urine following a sudden strong urge to urinate. This urgent need to urinate may occur during the day and often at night as well. Urgency, frequency and nocturia (going too frequently in the night) are symptoms of an ‘overactive or irritable’ bladder. The smooth muscle pump of the bladder is spasming or contracting giving rise to this urgency. Urine is composed of water, electrolytes, and other waste material that has been filtered out of the blood in your kidneys. Urine is then transported via the ureters to your bladder, where it is stored. Once full, the muscles in the wall of your bladder contract forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage of urine. These muscles relax at the same time the bladder contracts in order to allow urine to exit your body.

Signs and symptoms of urge urinary incontinence include:

  • The strong urge to urinate followed by the leakage of urine
Many women also experience triggers, or anything that increases the urge to urinate including running water, cold, or the thought of urinating.


What Causes Urge Urinary Incontinence?

The dysfunction is a combination of problems with the bladder, urethra, vagina, pelvic floor and nervous system. The first step is to understand that the urgency that you feel is generated centrally through the nerve connections from the bladder to the brain. The nerves to the brain get confused. They cannot tell whether the bladder is actually full or whether they are receiving a false and urgent message, these stimulus trigger the brain to mistakenly tell us to go to the toilet. We need to deny the urge to fix the circuitry problem.

There are several causes for urge urinary incontinence, these include:

Alcohol and Caffeine Alcoholic drinks and caffeine cause your bladder to fill more quickly and can trigger a strong uncontrollable urge to urinate. Bladder irritants Carbonated drinks, citrus juices, artificial sweeteners, tea, and coffee can irritate your bladder and worsen urge incontinence. Even teas and coffees without caffeine are irritants. Nicotine is also a bladder irritant. Dehydration When dehydrated, your urine becomes very concentrated. This highly concentrated urine can irritate your bladder and worsen urge incontinence. Urinary tract infection During a urinary tract infection, bacteria can irritate your bladder. This can result in strong urges to urinate, increased frequency, and incontinence. Constipation The bladder and rectum have a common nerve supply. Constipation causes compacted stool in the rectum which over-activates these nerves, increasing urinary urgency and frequency. Overactive bladder Overactive bladder is when nerves send signals to the bladder at the wrong time, causing it to contract at an inappropriate time leading to incontinence. Aging As you age, the capacity of your bladder to store urine decreases and the frequency of overactive bladder symptoms increases. The risk of overactive bladder also increases with various blood vessel disorders, seen more commonly in the elderly. Interstitial cystitis This is a painful condition that involves inflammation and scarring of the bladder wall. Symptoms include painful, frequent urination as well as urinary incontinence. Hysterectomy and other surgery The bladder and uterus are very close together and have common supporting ligaments and muscles. Removal of the uterus as in hysterectomy, risks damage to structures supporting the bladder. If these supporting structures are damaged, a prolapse or cystocele is likely to occur. Symptoms of a cystocele include urinary incontinence. Additionally, surgery may damage the nerves that supply the bladder, also leading to urinary incontinence. Bladder cancer or bladder stones Symptoms of bladder cancer or bladder stones include urinary incontinence, urgency, frequency, and painful urination. Other symptoms include blood in the urine and pelvic pain. Neurological damage Any neurological disorder such as multiple sclerosis, Parkinson's disease or stroke can cause urinary incontinence by interfering with the nerve signals that control the bladder. Additionally, if the nerves supplying the bladder or pelvic floor muscles are damaged, urinary incontinence may result.  

How is Urge Urinary Incontinence treated?

Treatments of urge urinary incontinence are tailored to suit your individual problem. The following should be considered: Pelvic floor muscle strengthening Strengthening the supporting muscles of your bladder is very effective in helping stress urinary incontinence. Biofeedback, or the use of special computer equipment to measure muscle activity, can help improve muscle control. Electrical stimulation can also assist in strengthening the pelvic floor muscles. Bladder training Bladder retraining is the technique used to try to increase the capacity of the bladder and decrease the sensitivity of the bladder. By teaching your bladder how to store more urine without leaking or giving uncomfortable spasms, you will have more time between voids, less discomfort and more freedom to go out. This is a disciplined program to suppress an overactive bladder. Expect the program to take at least 3 months to have a positive effect Defecation training Medication to calm the bladder, this is normally initiated after 3 months, talk to your doctor Vaginal oestrogen, if you are post menopausal Surgery – very rarely  

Normal bladder function

  • fluid intake of 1.5- 2 litres
  • normal frequency of voiding (passing urine) 4 – 6 times a day (every 2-3 hours) and perhaps once at night
  • each time you void, you should pass 250 – 500ml (1-2 cups) of urine
  • if you get the urge to void, you should be able to comfortably defer until it is convenient for you to go to the toilet
  • when you pass urine, it should flow in a steady continuous stream, without hesitation, until your bladder is empty
  • you should not need to push or strain to pass urine
  • you should be able to pull up on your pelvic floor when the flow of urine is finished, before you stand up
  • urine should be pale yellow coloured, it may be darker in the morning as it is more concentrated.
If your urine is always dark it is a sign that you are not drinking enough.

Pelvic Pain in Pregnancy

Pelvic and Pubic Pain in Pregnancy

What cause it?

The ligaments holding the pelvic bones together become soft and stretch due to hormones (relaxin). This leads to an unstable pelvis. Pain or instability can occur at any of the pelvic joints
  • The pubic bone at the front can separate from 2 – 3 mm, this starts from as early as 8 weeks, it can separate as far as 10 mm and this is when symphysis pubis dysfunction is diagnosed.
  • The joints at the back (sacroiliac joints) also stretch making this joint unstable which causes pain and dysfunction
Changes in weight and posture also affect the position of the pelvis, which in turn makes it more difficult for the muscles to stabilise the pelvis as they are stretched and weakened. 1 in 5 women will suffer with pelvic instability with about 5% having serious problems

Symptoms Include:

  • Pain in the front or back of the pelvis, groin, buttock, thigh, hip and lower back
  • Difficulty walking or a waddling walking pattern
  •  Pain when standing on 1 leg
  •  Pain when turning or twisting
  • Rolling in bed
  •  Clicking/clunking sounds from the pelvis
  •  Pain when opening your legs

Patello-femoral Knee Pain

Patello-femoral Knee Pain

Aching knees affect 25 % of the population and are commonly caused by dysfunction at the patella-femoral joint (under the kneecap). It is typically aggravated by bending movements such as sitting, walking up and down stairs or hills, jumping and running. It is also common during adolescence as the long bones are growing faster than the muscles, tendons and ligaments putting abnormal stress on the joints.


  • Unfortunately genetics have a part to play and this can’t be changes
  • Faulty bio mechanics due to muscle imbalances


Treatment is very successful and we will look at correcting muscle imbalances throughout your lower back, hip, pelvis and leg. This is done by manual techniques to the knee cap, massage, acupuncture, exercise and taping.

Falls Prevention – Balance

Falls Prevention – Balance

What is a fall?

  • The World Health Organisation defines a fall as "inadvertently coming to rest on the ground, floor or lower level, excluding intentional change in position to rest in furniture, wall or other objects". Falls in older people cover a wide range of events, including:
  • trips on raised obstacles (eg. loose rugs, cords, mats) or uneven surfaces (eg. footpaths, roads)
  • slipping on wet or highly polished surfaces
  • tumbles and stumbles down steps or stairs
  • falling off a ladder or stepladder
  • falling over in a shopping centre or while using public transport.

What a fall is not:

  • Falls in older people are not accidents. Similarly, falls are not an inevitable or unavoidable part of life. The causes of a fall can usually be identified and the sequence of events leading up to the fall can be predicted and therefore can be prevented.
  • Unintentional falls continue to be the leading cause of injuries requiring hospitalisation in Australia.

Risk factors for falls


Physical inactivity

  • Physical activity has been shown to be the most promising falls prevention strategy, both as a single intervention and as a part of a multi-factorial approach.
  • Research shows that specific exercises such as Tai Chi, balance, gait training and strength building group classes or individualised in-home programs reduce falls risk by 12% and the number of falls by 19%.
  • These interventions can also increase the time before a person falls for the first time. A physical activity program should be specific for individuals and include exercise that challenges balance at a moderate to high extent with a attendance twice weekly.

What you can do to prevent this

Physical activity is key to preventing falls and improving well being!  A holistic program including:
  • Proprioceptive retraining – challenging your body on unstable surfaces such as wobble discs and bosu balls helps to retrain your ability to recognise where your body is in space.
  • Strengthening – a full body strength program including lower limb, upper limb and core strengthening will help to mitigate the loss of muscle mass common in the older population. Exercises such as squats, bridges, push ups and calf raises are useful examples of this.

Other modifiable risk factors for falls

  • Problems with bowel and bladder control can impact on an older person's ability to stay active, healthy and independent.
  • Incontinence, urinary frequency and assisted toileting have been identified as falls risk factors for residents in residential aged care facilities.
  • Physiotherapy can assist with incontinence.
  • Sore, aching or tired feet make it difficult for an older person to stay active and independent, and can affect the way they walk.
  • Some types of footwear such as slippers, thongs or scuffs, and wearing socks without shoes can increase the risk of falls.
Low vision
  • Low vision, impaired vision, a change to vision or vision affected by medication can increase the risk of an older person falling. Vision impairment ranks sixth in the world's major causes of loss of wellbeing, and the prevalence of vision loss increases with age.
  • There is strong evidence that falls risk is increased by medications which act on the central nervous system, such as those used to treat depression, sleep disorders and anxiety.
  • For those using these medications to assist with sleep disorders and anxiety related health issues, there is a need for longer term support and use of non-pharmacological alternatives such as relaxation, reducing caffeine intake, increasing physical activity and meditation in the first instance.
Home safety
  • The relative risk of falls can be reduced by 20% in those with a history of falling by an occupational therapist conducting a thorough home risk assessment and arranging the recommended modifications.
  • Tidying up behind you and not leaving objects on the floor can also help to prevent falls.
  • Nutrition is an important factor in falls prevention, as frailty results from a loss of muscle mass and strength, neuromuscular impairment, immobilisation and malnutrition.
  • Older Australians are at risk of developing nutritional health problems due to reduced energy needs and a decreased ability to absorb nutrients.

Falls can be prevented!  Staying healthy and active, maintaining strength and balance, identifying falls risk factors and improving home safety will help to minimise the risk of falling.

Talk to your physiotherapist today about minimising your falls risk factors or join our fit for life program.